Program Registration

Participants Name: *
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Email: *
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Street Address: *
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City: *
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Zip *
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Home Phone: *
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Emergency Contact #: *
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Session: *
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Payment Method:
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Please note that online registration requires payment by Paypal (Visa / Mastercard / Paypal Account) * A paypal account is not necessary.
Waiver: I understand that a certain amount of risk is inherent to some recreational programs, I hereby, for my child, my heirs, executors, and administrators, waiver and release any and all rights and claims for damages I or my child may have against Penfield Fitness & Racquet Club and it’s representatives, successors and assigns for any and all injuries suffered by myself or my child at any activity sponsored in these groups.
I agree to the terms of the waiver *

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My Name: *
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Verification Code: Verification Code:
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